Provider Demographics
NPI:1578340931
Name:HUISACAYNA ALVIS, TONNY ALEJANDRO (CPED)
Entity Type:Individual
Prefix:
First Name:TONNY
Middle Name:ALEJANDRO
Last Name:HUISACAYNA ALVIS
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203
Mailing Address - Country:US
Mailing Address - Phone:908-884-8888
Mailing Address - Fax:908-862-0028
Practice Address - Street 1:1901 E LINDEN AVE
Practice Address - Street 2:UNIT 22
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036
Practice Address - Country:US
Practice Address - Phone:908-862-3121
Practice Address - Fax:908-862-0028
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45PD00001300224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthistGroup - Single Specialty